Provider Demographics
NPI:1750139713
Name:JOHNSON, TAYLOR D (AMFT)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41661 ENTERPRISE CIR N STE 111
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5629
Mailing Address - Country:US
Mailing Address - Phone:951-319-9434
Mailing Address - Fax:
Practice Address - Street 1:41661 ENTERPRISE CIR N STE 111
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5629
Practice Address - Country:US
Practice Address - Phone:951-319-9434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124253101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty